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Acrodynia is a rare condition that is typically seen in infants and young children resulting from exposure to a variety of heavy metals (commonly to mercury and mercury-based compounds).

What are the other Names for this Condition? (Also known as/Synonyms)

  • Bilderbeck’s Disease
  • Pink Disease
  • Swift-Feer Disease

What is Acrodynia? (Definition/Background Information)

  • Acrodynia is a rare condition that is typically seen in infants and young children resulting from exposure to a variety of heavy metals (commonly to mercury and mercury-based compounds). It results in pinkish discoloration of the skin on the hands and feet
  • The exposure is usually chronic and long-term. The source of exposure may be wide-ranging and includes dental amalgams, broken thermometers, various medications (such as laxatives and antimicrobial drugs), etc.
  • The signs and symptoms of Acrodynia comprise loss of skin layers, peripheral neuropathy, vomiting and diarrhea, renal failure, and memory loss and loss of focus. The condition is diagnosed by complete medical history and physical exam, and through tests to establish the levels of heavy metals in the body
  • Acrodynia is generally treated by removing the affected individual from the source of the exposure, and through antibiotics and chelation therapy. The prognosis depends on several factors including when the individual is removed from the source of toxicity
  • Acrodynia is uncommon nowadays due to more stringent regulations and restricted use of mercury and other heavy metals

Who gets Acrodynia? (Age and Sex Distribution)

  • Infants and young children are affected by Acrodynia following longstanding exposure to heavy metal based compounds
  • Generally, older children and adults are not affected by this condition
  • Both males and females are affected and no particular preference is observed
  • The condition is seen to affect all races and ethnic groups

What are the Risk Factors for Acrodynia? (Predisposing Factors)

The major risk factors associated with Acrodynia is exposure conditions. Exposure to the chemical compound may occur from the following sources:

  • Accidental mercury ingestion through broken thermometers
  • Use of amalgams for dental works
  • Certain antimicrobial medications
  • Laxatives and diuretics containing the causative compounds
  • Diaper rinse solutions
  • Batteries for watches
  • Antiseptic creams
  • Teething powders

Note: It is very important to note that most of the above compounds were risk factors prior to stringent governmental regulations regarding mercury and other heavy metal use were in place. Hence, currently the incidence of Acrodynia, due to the above risk factors, is on the decline.

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Acrodynia? (Etiology)

The cause of Acrodynia is generally due to repeated exposure either through oral ingestion (usually acute) or skin contact and inhalation (which is mostly chronic).

  • Exposure may be through a variety of compounds or environmental conditions
  • The heavy metals that can cause the condition include mercury (most common), gold, arsenic, thallium, and many others
  • Genetic sensitivity to heavy metal poisoning is considered a cause

What are the Signs and Symptoms of Acrodynia?

The signs and symptoms of Acrodynia depend on whether the exposure occurred through oral ingestion, chronic inhalation, or skin contact. It also depends on the type of heavy metal that was involved. The signs and symptoms vary from one individual to another. The condition may be initially observed as a viral infection.

General signs and symptoms associated with Acrodynia include:

  • Pinkish discolored skin of the hands and feet, and also on the tip of the nose (due to an allergic reaction of the skin to the chemical)
  • Pain, burning or itching sensation due to peripheral neuropathy
  • Loss of superficial layers of skin - a process called desquamation
  • Weight loss, loss of appetite
  • Fatigue
  • Ulcers on the gums
  • Loss of muscle tone
  • Excess saliva production; being excessively thirsty (polydipsia)
  • Depression; lack of focus
  • Children can become cranky and show aggressive behavior

Other signs and symptoms of Acrodynia may include:

  • Increased heart rate (tachycardia)
  • Excessive sweating (which may lead to frequent skin infection)
  • Increased blood pressure
  • Hair loss
  • Skin rashes that come and go
  • Difficulty in seeing bright light or photophobia
  • Anxiety, nervousness, and irritability
  • Loss of memory
  • Loss of sleep, difficulty in sleeping

In infants and small children, when the condition is termed Infantile Acrodynia (or Pink Disease), the following signs and symptoms may be manifested:

  • Pinkish discolored skin of the hands and feet
  • Significant swelling of the affected region
  • Constant crying in infants
  • Redness in cheeks
  • Running nose
  • Enlarged tonsil
  • Initially vomiting and diarrhea; later in many children the condition may result in constipation

How is Acrodynia Diagnosed?

A diagnosis of Acrodynia may involve the following tests and procedures:

  • A complete physical examination and comprehensive medical history evaluation (including procuring information on exposure to heavy metals)
  • Complete blood count
  • Liver function tests
  • Blood urea nitrogen (BUN) test
  • Creatinine test
  • Mercury testing: It is used to examine the levels of mercury in blood, urine, and rarely, in hair
  • Heavy metals panel blood and urine test: Increased level of proteins in urine may be observed
  • Nerve conduction studies

A differential diagnosis may be undertaken to exclude the following conditions:

  • Pheochromocytoma
  • Kawasaki disease
  • Acanthosis nigricans
  • Poliomyelitis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis. 

What are the possible Complications of Acrodynia?

The complications of Acrodynia could include:

  • Weakening of the gums leading to loss of teeth
  • Early hair loss (alopecia)
  • Loss of fingernail and toenail
  • Chronic mercury exposure leads to kidney failure
  • Skin sensitization through chronic skin exposure resulting in skin abnormalities
  • Gastrointestinal complications including diarrhea and vomiting with blood due to prolonged exposure
  • Electrolyte imbalances can result in severe damage to vital organs
  • Longstanding exposure can result in decreased academic performance

Coma and death can result from ingestion of heavy metals.

How is Acrodynia Treated?

The treatment for Acrodynia is determined based on the severity of the symptoms and the mode of toxic exposure. Generally, there is no specific treatment for a chronic exposure. The most important treatment measure is removing the individual from the source of exposure and preventing further exposure to the toxic material.

  • For exposure through skin contact, the following treatment measures may be employed:
    • Removal from the toxic source of exposure
    • Flushing of the eyes with water, if the eyes or skin are acutely exposed
    • Antibiotic creams to avoid secondary infections in skin ulcers
  • For exposure due to oral ingestion, the following treatment measures may be employed:
    • Fluids and electrolytes may be administered to maintain electrolyte balance
    • The ingested element/chemical may be passed out through bowel movement or urine
  • For exposure through inhalation, the following treatment measures may be employed:
    • The primary goal is to remove the affected individual from the source of exposure
    • If the lungs are damaged, then breathing assistance (or oxygen) is provided
  • Chelation therapy
  • Any underlying complication may have to be treated on a case-by-case basis

How can Acrodynia be Prevented?

Acrodynia may be prevented by eliminating exposure to sources of mercury and other heavy metals. The following points may be considered towards preventing poisoning by these chemical compounds.

  • Regularly shower and change clothes after industrial work. Avoid bringing home contaminated clothes from the work site
  • Practice proper hand hygiene by washing hands with soap frequently
  • Ensure that industrial safety regulations for heavy metal exposure is adhered to at workplaces

What is the Prognosis of Acrodynia? (Outcomes/Resolutions)

  • The prognosis for Acrodynia is dependent on when the individual or child is removed from the potential source of toxic compounds. The sooner the individual is removed, the better is the prognosis
  • The prognosis is also dependent upon the amount of heavy metal one is exposed to. Individuals who are exposed to large amounts of toxic metals orally or through inhalation for longer durations may have worse prognosis
  • With prompt diagnosis and appropriate treatment, children who have been acutely exposed to the chemical compounds generally have excellent prognosis. However, it is important to note that the signs and symptoms do not get better immediately, but slowly with time

Additional and Relevant Useful Information for Acrodynia:

Acrodynia, when the exposure is particularly due to mercury, is also known as Swift’s Disease or Mercurialism.

What are some Useful Resources for Additional Information?

National Institute for Occupational Safety and Health
395 E Street, S.W. Suite 9200, Patriots Plaza Building, Washington, DC 20201
Phone: (513) 533-8328
Toll-Free: (800) 232-4636
Email: cdcinfo@cdc.gov
Website: http://www.cdc.gov/niosh

Center for Health, Environment and Justice
P.O. Box 6806, Falls Church, VA 22040-6806
Phone: (703) 237-2249
Email: info@chej.org
Website: http://www.chej.org

American Academy of Dermatology
930 E. Woodfield Road Schaumburg, IL 60173
Phone: (866) 503-SKIN (7546)
Fax: (847) 240-1859
Website: http://www.aad.org

References and Information Sources used for the Article:

http://www.dermnetnz.org/topics/acrodynia/ (accessed on 01/08/2017)

https://www.ncbi.nlm.nih.gov/pubmed/21797771 (accessed on 01/08/2017)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3173747/ (accessed on 01/08/2017)

Helpful Peer-Reviewed Medical Articles:

Yeter, D., & Kuo, H. C. (2015). Acute Febrile Acrodynia (1781-1966): Historical Cases Of Kawasaki Disease Before Kawasaki?.

Khodashenas, E., Aelami, M., & Balali-Mood, M. (2015). Mercury poisoning in two 13-year-old twin sisters. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences, 20(3), 308.

Esra, Ç. Ö. P., KÜLTÜR, S. E. Ç., & BAKAR, P. E. E. (2014). Metallic mercury poisoning and neuropsychological effects: a case report. Turk psikiyatri dergisi, 25(1), 60.

McKay, C. A. (2013, December). Public health department response to mercury poisoning: the importance of biomarkers and risks and benefits analysis for chelation therapy. In Journal of medical toxicology (Vol. 9, No. 4, pp. 308-312). Springer US.

Singhvi, R., Taneja, A., Patel, J., Gasser, C., & Kalnicky, D. J. (2014). Hg vapor emission from broken compact fluorescent lamps (CFLs) in an acrylic chamber. Environmental Forensics, 15(1), 17-24.

Seshadri, S. (2013, October). Mad As a Hatter. In 2013 AAP National Conference and Exhibition. American Academy of Pediatrics.

Horowitz, Y., Greenberg, D., Ling, G., & Lifshitz, M. (2002). Acrodynia: a case report of two siblings. Archives of disease in childhood, 86(6), 453-453.

Casano, P., Odena, M. P., Cambra, F. J., Martin, J. M., & Palomeque, A. (2002). Bordetella pertussis infection causing pulmonary hypertension. Archives of disease in childhood, 86(6), 453-453.